“At his or her core, an ethicist is one who thinks deeply about matters of right or wrong” (Burroughs, 2016)
My greatest ethical struggles in clinical practice have been dealing with my own judgement of prisoners, balancing workloads and time constraints, lack of resources, and adjusting the way I practice on a daily-to-weekly basis to suit others.
Most clinicians and supervisors have unique ways of practicing physiotherapy and expects students to conform to their way; forcing students, such as myself, to change their practice. Doing what I believe is right, based on my education and guidance, in a situation where a specific clinician, supervisor, or protocol points to another direction was challenging and uncomfortable. I think it was uncomfortable as handling a particular condition against what I believe made me feel I was compromising on my morals. Another uncomfortable situation I experienced was when I addressed my own subconscious judgement of a prisoner, this was uncomfortable for me as I believed I was free of judgement.
An issue I struggled with at the end of this year, after final posts were posted, is the issue of time constraints. This seems more of an administrative/time management issue however it began compromising my practice. This is another uncomfortable point I will expand on later.
When beginning this course I thought reflecting on an ethical issue in my practice would feel like another “dear-diary” entry. This was due to a previous clinical requirement of a weekly reflection, which had little to no impact on my daily practice.
This course however managed to open my eyes concerning topics I was already thinking about at depth. “The right to judge” is a post in my current IEP portfolio where I discuss judgment of a person subconsciously. The definition of a thought being subconscious is that you are not aware of it taking place. Now by definition it may seem strange that I noticed a subconscious thought, however in reality it is quite simple. Attending ethics module classes and discussing judgment of patients got me thinking about HOW I judge, WHY I judge, and WHEN I judge. I must admit that after thinking through this I found myself to be “quite ethical” in my daily dealings and responses to different patients. This had me pleased with my current practice and the progress I had made from first year, I left it there. However by thinking through this topic of judging and gaining other peer’s views on judgement I had the topic in mind during practice. By thinking about how people judge and noticing judgement in others a situation arose where I noticed my own subconscious judgement. This identification only occurred due to the encouragement given by this module to scrutinize my own practice and shortcomings.
After identifying this shortcoming in myself I started putting the situation and my thoughts down on paper. Blogging about it opened up HOW I was judging, WHY I was judging, and WHEN I was judging, which as I mentioned before I thought I was not doing. I was able to identify the exact moments I was doing all of the above, allowing me to take that forward in to clinical practice and improve as a student, soon to be clinician.
This is not an isolated situation for me; all of my posts were inspired by scrutinizing my practice, the situation I was in, and at one point someone else’s practice. Critical reflection is thought of as being a process by which one analyses their practice, learns from the analysis and issues that arise, and constantly adjusts their practice (Delany & Watkin, 2008, p. 412). In my own practice I noticed that I can treat patients ethically to the best of my ability, however the best of my ability means I need put in extra work to ensure patients are receiving the best treatment available according to the latest research. When taking note of my surroundings such as in “resource allocation” I was not making a judgement on those who spent their budget as they pleased, I was more focused on how I may allocate funds better, to benefit patients, when in charge of my own budget. When identifying the situation in someone else’s practice I was not judging their particular view and actions, I was rather using the situation to identify an issue in order to not let it occur in my own practice.
Ethics has given me an altered viewpoint on clinical practice that I believe benefits me, my peers, my colleagues, and most importantly my patients. The use of blogging has given me the structure and platform necessary to lay thoughts out, make sense of them, receive constructive criticism, and improve on my posts. As was stated by Rowe, 2012 exposing my understanding of ethical issues to others for correction and guidance has helped me develop as a professional. Receiving guidance from a more knowledgeable other has shown to be an effective method of learning for me during this course (Rowe, 2012, p. 469). This platform also allowed writing to appear more appealing and capturing, benefiting me and hopefully also the readers. Along with all of these other benefits providing references has helped me to look further in to the thoughts, see what other people are thinking, and incorporate these points in to more well-rounded work, and essentially practice.
Professional values cannot simply be understood and put in to practice; they mature with practice experiences accompanied by collective discussion and debate. (Grace & Trede, 2013, p. 794-795) Commenting on peer’s posts allowed me to see how other people view a situation, potentially influencing my own thoughts, and allowing me to adjust my view to be better-rounded as mentioned above. Another benefit of reading and commenting on other’s posts is they have experienced situations I have not yet experienced. I viewed their media, their references, and read their thoughts which I can now use in the future to assist in more ethical dealings during the same situations. In this post my eyes were opened to the potential abuse of my peer’s and myself by patients, I have not dealt with a situation like this however I now know how a person in the situation views it and how they cope. In this post I see valid points about getting in to physiotherapy to help patients, however when dealing with terminally ill patients, which I have not experienced, I will take his points forward in to my own practice. These are just two of the many posts I found intriguing and that may be useful going forward.
When managing moral comprise, something that luckily occurs infrequently in my clinical practice, I have noticed a change in my thinking. There are two possible reasons I may have started practicing what I believe is right; it may be related to this course or being close to qualifying. I prefer to think that it is a combination; this course has better prepared me as a student to make decisions and take a stand regarding what I believe is right, something I will be doing as a qualified physiotherapist.
I believe that the issue I brought up earlier of rushing through treatments with patients because I am time-pressed is unfair on them. Giving every patient the best treatment possible from me is a theme I have posted about here and has allowed me to consolidate this as an uncompromisable trait of my practice. Thinking more about this and arguing for why I believe it is important has improved my practice. During clinical practice I will now rather give of my time; tea, lunch, and stay over time than compromise my treatments.
When faced with ethical problems in clinical practice the alternatives to ethical reasoning are that we merely follow rules or codes of behaviour, not applying them to a patients’ specific circumstance. We may also treat patients according to our own personal beliefs or values which, if unreflected upon or unchallenged, could at times also be our prejudices. (Edwards, Braunack-Mayer, & Jones, 2005, p. 229) Due to the nature of this course I had to look at my own clinical practice and critically reflect on it, as stated above in all scenarios this reflection allowed me to highlight points of my own practice to improve. Identifying these points and delving deeper allowed me to see where I was/am weak in my ethical practice. I was also able to have my own personal beliefs and values scrutinized by others, allowing a challenge to my belief. Identifying where my weaknesses and prejudices were/are allowed me to intervene and curb, or stop, these issues where they start; this is an important skill that was learnt over this course. I view my clinical practice vastly differently to the way I did at the beginning of the year and believe many improvements were made. However as with anything in life I am not perfect, far from it in fact, making the tools I gained from this module even more important. There is no doubt that moral compromise, ethical issues, and uncomfortable situations will arise in the future, I accept this and feel better prepared to use the tools I have gained to manage the situations and continually improve.